CONTINUITY OF CARE & OUTCOME OF SEVERE MENTAL DISORDERS

一项为期五年的研究和教育计划，旨在为首席研究员在精神卫生服务研究方面的职业生涯做好准备，重点关注严重精神障碍患者。候选人的长期研究目标是在这些患者群体的服务研究中应用流行病学的严格方法和分析工具，并调查他们的护理的最佳方法，特别是在疾病的早期阶段。这种知识对于为这一人口规划基于经验的服务至关重要。该项目有两个主要组成部分：一个教育计划和一个研究项目。教育计划包括流行病学、生物统计学和精神卫生服务研究方面的课程。此外，一组在精神病学流行病学、精神卫生服务研究、早期干预和精神分裂症研究方面经验丰富的专家将提供指导、监督和咨询。研究和教育项目将在哥伦比亚大学精神病学部门进行，并与其他一些机构的研究人员合作。本研究旨在探讨持续性护理对首次入院的精神分裂症及情感性精神病患者病程及预后的影响。近年来，早期治疗生涯对精神障碍患者后续病程和预后的影响备受关注。该项目侧重于护理的连续性，这是早期治疗生涯的基本要素。护理的连续性在这里被定义为服务系统将治疗事件连接成一个无缝整体的程度。在两个样本中，将检查护理连续性对患者短期和中期病程和结果的影响：a)萨福克县心理健康项目（SCMHP），一项针对纽约州萨福克县首次入院精神病患者的流行病学纵向研究；b)国家早期精神病和自杀合作研究（NCSEPS），一项针对美国军人中首次入院的精神分裂症和情感性精神病患者的大规模研究，并通过VA服务进行随访。该项目有四个具体目标，前三个与SCMHP样本有关，第四个与NCSEPS有关。具体目的是：1)描述精神分裂症和情感性精神病患者的治疗生涯；2)研究病程早期护理连续性对24个月和48个月预后的影响；3)确定不同诊断组的连续性护理对结局的影响是否相似；4)在NCSEPS样本中，研究了对首次在军队医院诊断为精神分裂症或情感性精神病并在出院后转介到退伍军人事务部系统继续治疗的男女军人的护理不连续性的影响。

A five-year research and educational program is proposed to prepare the principal investigator a career in mental health services research with a focus on patients with severe mental disorders. The candidate's long-term research goal is to apply the rigorous methods and analytic tools of epidemiology in services research for these patient groups and to investigate the optimal approaches to their care, especially in the early phases of the illness. Such knowledge will be essential for planning empirically-based services for this population. The program has two major components: an educational plan and a research project. The educational plan involves course work in epidemiology, biostatistics and mental health services research. In addition a group of highly experienced experts in psychiatric epidemiology, mental health services research, early intervention and schizophrenia research will provide tutorials, supervision and consultation. The research and educational programs will be pursued at the Department of Psychiatry, Columbia University, in collaboration with researchers in a number of other institutions. The research project aims to investigate the impact of continuity of care on the course and outcome of the first admission patients with schizophrenia and affective psychoses. The impact of early treatment career on the subsequent course and outcome of psychotic of psychotic disorders has attracted much attention in recent years. This project focuses continuity of care which is an essential element of the early treatment career. Continuity of care is defined here as the degree to which the service system links episodes of treatment in a seamless whole. The impact of continuity of care on the short- and medium term course and outcome of patients in two samples will be examined: a) the Suffolk County Mental Health Project (SCMHP), an epidemiological longitudinal study of first admission psychotic patients in Suffolk County, New York, and b) the National Collaborative Study of Early Psychosis and Suicide (NCSEPS), a large- scale study of first admission patients with schizophrenia and affective psychoses among US military personnel with follow-up through VA services. The project has four specific aims, the first three pertain to the SCMHP sample and the fourth to the NCSEPS. The specific aims are, 1) to describe the treatment career of patients with schizophrenia and affective psychoses; 2) to study the impact of continuity of care in the early course of illness on the 24- and 48-month outcomes; 3) To determine whether the impact of continuity of care on outcomes is similar for different diagnostic groups; and 4) in the NCSEPS sample, toe examine the impact of discontinuity in the care of servicemen and -women who are admitted for the first time in the military hospitals with a diagnosis of schizophrenia or affective psychosis and are referred to the VA system for continuation of treatment after discharge.